Biological therapy in women with inflammatory bowel disease during pregnancy

Czech version

Authors: Jana Koželuhová; Karel Balihar; Eva Janská; Lucie Fremundová; Martin Matějovič
Authors‘ workplace: Gastroenterologické a hepatologické oddělení I. interní kliniky LF UK a FN Plzeň, přednosta prof. MUDr. Martin Matějovič, Ph. D.
Published in: Vnitř Lék 2014; 60(7-8): 630-634
Category: 100th Birthday - prof. Z. Mařatka

Overview

The aim of this article is to objective review available research data regarding the safety of biological therapies during pregnancy and breastfeeding in women with inflammatory bowel disease. Biological therapies appear to be safe in pregnancy, as no increased risk of malformations has been demonstrated. Available clinical results suggest that the efficacy of infliximab and adalimumab in achieving clinical response and maintaining remission in pregnant patients might outweigh the theoretical risks of drug exposure to the fetus. If possible, anti-TNF therapy should be stopped by the end of the second trimester due to transplacental transfer and potential risk for the fetus. The use of infliximab and adalimumab is probably compatible with breastfeeding.

Key words:
adalimumab –⁠ breastfeeding –⁠ inflammatory bowel disease –⁠ infliximab –⁠ pregnancy

Sources

1. Ng SW, Mahadevan U. My treatment approach to management of the pregnant patient with inflammatory bowel disease. Mayo Clin Proc 2014; 89(3): 355–360.

2. van der Woude CJ, Kolacek S, Dotan I et al. European evidenced-based consensus on reproduction in inflammatory bowel disease. J Crohns Colitis 2010; 4(5): 493–510.

3. Gisbert JP, Chaparro M. Safety of anti-TNF agents during pregnancy and breastfeeding in women with inflammatory bowel disease. Am J Gastroenterol 2013; 108(9): 1426–1438.

4. Huang VW, Habal FM. From conception to delivery: managing the pregnant inflammatory bowel disease patient. World J Gastroenterol 2014; 20(13): 3495–3506.

5. Mahadevan U, Wolf DC, Dubinsky M et al. Placental transfer of anti-tumor necrosis factor agents in pregnant patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2013; 11(3): 286–292.

6. Vermeire S, Carbonnel F, Coulie PG et al. Management of inflammatory bowel disease in pregnancy. J Crohns Colitis 2012; 6(8): 811–823.

7. Bortlik M, Machkova N, Duricova D et al. Pregnancy and newborn outcome of mothers with inflammatory bowel diseases exposed to anti-TNF-alpha therapy during pregnancy: three-center study. Scand J Gastroenterol 2013; 48(8): 951–958.

8. Dubinsky M, Abraham B, Mahadevan U. Management of the pregnant IBD patient. Inflamm Bowel Dis 2008; 14(12): 1736–1750.

9. Mahadevan U, Cucchiara S, Hyams JS et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn’s and Colitis Organisation: pregnancy and pediatrics. Am J Gastroenterol 2011; 106(2): 214–223.

10. Selinger CP, Eaden J, Selby W et al. Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohns Colitis 2013; 7(6): e206-e213.

11. Nielsen OH, Loftus jr. EV, Jess T. Safety of TNF-alpha inhibitors during IBD pregnancy: a systematic review. BMC Med 2013; 11 : 174.

12. Schnitzler F, Fidder H, Ferrante M et al. Outcome of pregnancy in women with inflammatory bowel disease treated with antitumor necrosis factor therapy. Inflamm Bowel Dis 2011; 17(9): 1846–1854.

13. Yarur A, Kane SV. Update on pregnancy and breastfeeding in the era of biologics. Dig Liver Dis 2013; 45(10): 787–794.

14. Mahadevan U, Martin CF, Sandler RS. PIANO: A 1,000-Patient Prospective Registry of Pregnancy Outcomes in Women with IBD Exposed to Immunomodulators and Biologic Therapy. A special meeting review edition: Highlights in Crohn’s Disease and Ulcerative Colitis: Digestive Disease Week 2012 May 19–22, 2012, San Diego, California. Gastroenterol Hepatol 2012; 8(8 Suppl 5): 1–24.

15. Koren G, Inoue M. Do tumor necrosis factor inhibitors cause malformations in humans. J Rheumatol 2009; 36(3): 465–466.

16. Zelinkova Z, Pierik MJ, Kuipers EJ et al. High intra-uterine exposure to infliximab following maternal anti-TNF treatment during pregnancy. Aliment Pharmacol Ther 2011; 33(9): 1053–1058.

17. Ng SW, Mahadevan U. Management of inflammatory bowel disease in pregnancy. Expert Rev Clin Immunol 2013; 9(2): 161–173.

18. Zelinkova Z, van der Ent C, Bruin KF et al. Effects of discontinuing anti-tumor necrosis factor therapy during pregnancy on the course of inflammatory bowel disease and neonatal exposure. Clin Gastroenterol Hepatol 2013; 11(3): 318–321.

19. Friedman S, Mc Elrath TF, Wolf JL. Management of fertility and pregnancy in women with inflammatory bowel disease: a practical guide. Inflamm Bowel Dis 2013; 19(13): 2937–2948.

20. Mahadevan U. Pregnancy and inflammatory bowel disease. Med Clin North Am 2010; 94(1): 53–73.

21. Bortlik M, Duricova D, Machkova N et al. Impact of anti-tumor necrosis factor alpha antibodies administered to pregnant women with inflammatory bowel disease on long-term outcome of exposed children. Inflamm Bowel Dis 2014; 20(3): 495–501.

22. Cheent K, Nolan J, Shariq S et al. Case Report: Fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn’s disease. J Crohns Colitis 2010; 4(5): 603–605.

23. Rahier JF, Ben-Horin S, Chowers Y et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2009; 3(2): 47–91.

24. Rahier JF, Magro F, Abreu C et al. Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2014; 8(6): 443–468.